Posted
by
Unknown Lamer
on Monday October 21, 2013 @12:03PM
from the operation-aca-freedom-eagle dept.

itwbennett writes "It's no secret that the healthcare.gov website has been plagued by problems since its launch 3 weeks ago. On Sunday, the Department of Health and Human Services said that it's now bringing in the big guns: 'Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the [HHS] team and help improve HealthCare.gov,' the blog post reads. 'We're also putting in place tools and processes to aggressively monitor and identify parts of HealthCare.gov where individuals are encountering errors or having difficulty using the site, so we can prioritize and fix them.' Other emergency measures being taken as part of what HHS calls a 'tech surge' include defining new test processes to prevent new problems and regularly patching bugs during off-peak hours. Still unclear is how long it will take to fix the site. As recently reported on Slashdot, that could be anywhere from 2 weeks to 2 months."

That's the exact opposite economically to produce affordable healthcare for the whole nation. Sure poor people will have little incentive not to come in for every cough but someone will pay for it. That will tax our whole economy, not including dead weight loss inefficiencies.

you're confused. the whole reason we pay three times or more what more advanced countries do (yes kiddies, U.S. is not #1 for healthcare) is because of the big insurance and big healthcare full of fat cats lining their pockets. that system has to be destroyed. ACA just gives it more money. single payer might be viable solution but it will burn down some huge corporations. however, don't believe the lie that those big corporations are the main contributors or participants in our economy, people and small/medium business are the bulk of it.

The ACA exchanges are specifically designed to (a) help people buy in larger pools for discounts and (b) induce competition between insurance companies, to reduce prices.Where we don't have as much pressure is in healthcare, because people are not naturally inclined to go to a physician billing himself as the cheapest on the block. We as patients don't know how to evaluate the quality of the care we get, or its value, so we cannot effectively price the services we buy.

Where we don't have as much pressure is in healthcare, because people are not naturally inclined to go to a physician billing himself as the cheapest on the block.

The way to make up for that is by allowing customers to know the outcomes for various surgeries in the hospital. Once customers know the price and the outcomes, they can make informed decisions.

Price and outcomes are not always related. For example, a hospital that does many heart surgeries could be very good at them, and also very efficient, so they can do them more cheaply. Whereas another hospital that doesn't do many heart surgeries will need to charge more as a result, and also will have worse outcomes.

Whether prices are published or not, outcomes should definitely be published, because making that information public will be an incentive for hospitals/doctors to improve treatment even if nothing else changes.

Not say that is a bad idea, however you may not be aware that it has some very negative consequences within itself. Once the outcomes of all procedures are made publicly available, health care providers (such as surgeons) will start to refuse to perform procedures on patients who do not have a very high probability of success. In addition the general public will look for simple "pass/fail" information on the outcomes, when that is a completely unrealistic way of looking at it. The cold hard truth is that surgical outcomes have too many factors for the general public to be able to make a well informed decision on.

A thousand time this. Price discovery is almost unheard of in the medical industry. If patients were told prices and actually paid for service themselves (to be later reimbursed by insurance) you would see an immediate change in behavior as people shop the marketplace and prices rationalize. These are basic Free Market principles.

Do this experiment: next time you go to the Doctor, ask them the cost as if you were going to write them a check. Seems simple, right? What is the cost of "x", where x

> That information is already available, to some degree, to Medicare and private insurers.

In other words, it's really not.

Someone claimed that the US spends 3x more on medical care. That number could easily be accounted for due to bogus inflated hospital billing rates. The stated price and what gets paid vary wildly. These rates are treated like trade secrets and are greatly discounted if you are a large corporation.

Ultimately, it's about income redistribution. Those of us that can afford insurance are going to be subsidizing those that cannot.

Beyond that, the ACA regulates what products you can buy. It seeks to deny you options that allow you to better manage overall costs. It also regulates what and whom can be covered in a manner likely to increase premiums.

The do-gooders despise the idea that some of us might be self-reliant and seek to undermine that. They also despise

The income redistribution was already happening, except it happened in spurts (when people went to the ER, couldn't pay, and the hospital passed along the loss) or through the courts (when people went bankrupt, and we all paid for it when their creditors passed along the loss.)

Insurance, by its very nature, is always re-distributive. Those who don't need (today) pay for those who do (today). It evens out, eventually (there's no reason to expect those who are currently rich to be naturally healthier over their entire lifetime), but in the short term it's redistribution. We redistribute for basic needs -- food, shelter, and healthcare. We've had a mandate to that effect since 1986, under Reagan. It's not a particularly partisan issue to say that our fellow man doesn't deserve to die of some curable disease just because he can't currently pay for care. And it's not unreasonable to say we'd rather he go see a doctor while the problem is easy to fix, rather than wait until the last minute -- by doing so, he's doing us a favor (if we're footing the bill.) We may subsidize his care today, but if he recovers and thrives, he'll be paying back into that same insurance pool too.

We generally regulate what products people can buy. We do that with securities. With drugs. With food. Weaponry. Animals....

We have certification requirements for plumbers, lawyers, electricians, and yes, doctors. Does that increase the cost of the services? I'm pretty sure it does -- but the regulation wasn't done without reason. When you look at the history of deregulation of these industries, you see all sorts of calamities. A cheap self-described electrician can set fire to a whole neighborhood. A quack doctor could easily cause a pandemic. We're all affected.

Self-reliant today, but what about tomorrow? Will you willingly accept to be left in the gutter by the rest of society in your hour of need, because you deserve no better? Money is secondary to me. People come first.

The ACA does not prevent you from paying more, if you want to. So I'm not sure what that's about.

Single-payer was the original goal for the Democrats, yes. They dropped that rather quickly as it was clearly unpalatable to the Republicans. Instead we went with a Romney-care type of plan, already setup in Massachusetts. The individual mandate to buy at least catastrophic insurance with tax breaks to help people acquire it, were proposed by Mark Pauly and endorsed by the Heritage Foundation, during the 90's fight over Clinton's attempted healthcare refo

you're confused. the whole reason we pay three times or more what more advanced countries do (yes kiddies, U.S. is not #1 for healthcare) is because of the big insurance and big healthcare full of fat cats lining their pockets.

Saying that they line their pockets with money may be a fact, but it's not a reason.

The reason we collectively spend so much is because we have government spending competing with private spending for a finite amount of healthcare services.

It's this competition for limited services that bids prices up for everything. And as prices rise, some people are priced out of the market, justifying more government spending to help them, which further increases prices.

How about the time available to doctors and nurses to treat people? They can only treat so many people.

And there are psychological limits, too. Doctors and nurses may have time but not the will to devote 80 hours a week to watching people die.

There are also equipment limits. An MRI requires scarce materials and scarce skills to assemble.

There are countless things that limit the total amount of healthcare available.

Don't think like a mere consumer, where the perceived limit on what's available depends only on the money in your bank account. That's putting all the focus on the demand side of the equation. Try to see the big picture. To do that, you have to look at the supply side, too. The supply of most things is limited (ultimately by physics).

How about the time available to doctors and nurses to treat people? They can only treat so many people.

I'm not sure that counts as a limited resource, since it doesn't explain why we can't scale up on doctors or nurses to meet the demand. After all, we do have unemployment. I'm not saying you don't have a point, but you're being very picky that we get down to the reason why things are so expensive, and your explanation doesn't quite seem adequate. Scarcity of materials for MRIs could be a real limit, but it would only explain why MRIs are expensive. Why is the aspirin in hospitals so expensive? Aspirin isn't meaningfully limited.

no.just no.that is no where near the reason, and whomever modded you up isnt familiar with the industry or its cost drivers AT ALL.healthcare resources are no where near scarce in this country.the high costs are in no way shape or form being caused by a limited supply unable to keep up with demand.

Availability BECAUSE of widespread insurance. This drives up demand and screws with pricing since the people using it don't have to pay based on the type of service received. You see the same thing in our college education system, as the availability of 'free' education has gone up via grants and student loans that delay the financial pain, the costs have risen for essentially no improvement in services. When the lie took over that 'everyone has to have a college education to get anywhere', and everyone bought into it, it became far more expensive. The same type of lie has invaded our medical system; that 'everyone has to have access to health care, no matter what the real costs are'.

Newer, more expensive treatments. My fibula was broken in a motorcycle crash. The billed costs to fix it were over $72K and included a three day hospital stay, a plate in my ankle, several follow-up visits with the surgeon, including one more surgery, and months of physical therapy. 50 years ago, they probably would have thrown a cast on it in the emergency room and I would have limped the rest of my life. The facts are that people are receiving more and better treatments and living longer and better than they ever have before, and it's costing a crap load more money than it used to.

Duplicate/litigious-avoidance medical testing because insurance pays for it. I found it interesting when I had a high-deductible plan and started to question tests how many the doctors really didn't need to do but did so 'because insurance covers it'.

Insurance companies are some of the lowest margin companies in the US that have driven down health care costs by forcing hospitals and doctors to accept lower payments. It's a double edged sword, while they have helped drive costs down, the increased demand has driven it back up.

Tax laws and accounting procedures used by healthcare providers. Ever wonder why your hospital bill is $40K, but the insurance only pays $12K?? The $12K is the 'negotiated rate', while the $40K is the full rate. Everyone who fails to pay results in a $40K write-off for the hospital, not a $12K. And if you are in a car crash in many states, the hospitals can go after the at-fault person for the $28K difference. A friend of mine, who had chosen to not buy insurance where she works, needed an expensive procedure. When the hospital was offered cash, they took 50% off the price. So don't tell me that the prices being charged are real.

Lack of transparency/competition coupled with government subsidies. Why is it auto repair facilities have to give a detailed estimate and are held to it, yet our hospitals don't have to?? My son, who doesn't have insurance, hurt his ankle and went to the hospital. He wanted to get it checked, and being a responsible person was going to pay for it. The hospital was unwilling to tell him how much it was going to cost, so he left. However, the next day they called him back and told him they were able to get the state insurance program to pay for it.

No one is entitled to affordable health care, there is no reason why everyone should be able to have liver transplants regardless of income level. We should have access to fairly priced health care that we can work out the details of paying for it. And choose whether or not it's worth the money to us as individuals. Not the government deciding.

1: Nope.2: Nope.3: Contributes, but nearly as much as people think.4: Nope. In fact the opposite. Hospitals can get away with charging more because the insurers act a a shock absorber, insulator, between your wallet and the true cost of care. they dispute some, but not all excessive costs, because they act more as a match maker between patients and hospitals than a representative of the patient. in fact, it can be argued that hte true commodity is the patients, and the customers are the hospitals.5: Nope. Red herring. It contributes, but negligibly so.6: Finally got one right. Lack of competition and economic pressure. This single factor is responsible for the majority of high cost of healthcare in this country. Quite simply, healthcare costs so much because it can. Because they can get away with it. Because there is a middleman between our wallets and the caregivers, that sheilds us from direct costs. Because healthcare isnt like a car sale...you're not going to walk away from life saving surgery because it's too expensive.

It's as a simple as that. Number 6 is the single most important factor, all others are either false or negligible.

We should have access to fairly priced health care that we can work out the details of paying for it. And choose whether or not it's worth the money to us as individuals.

Again: no one actually does that. No one is ever going to do that. If I tell you you need to take these pills, that cost 100$ per pill, or you will die, you're not going to walk away and just accept death. People just dont do that. and since you care to mention government...the single most cost efficient sector of our healthcare system IS the government run single payer segments: Medicaire/Medicaide.

the largest, greediest most inefficient corporation. One that use lots of guns to enforce it's will.

Hey, what could go wrong?

Or perhaps we can enforce a market with true competition. Which is not what we have now.
"Oh Noz! Can't do that!" People must be forced to do the right thing by a vast, inefficient, "compassionate", smarter-than-we-are totalitarian state.

(former HMO IT guy) That 30% administrative cost is driven primarily by the hideous complexity of health care billing brought on by the mutli-payor insurance setup we have today. Every single line item on a hospital bill must be evaluated for who pays for it. That takes a lot of skilled labor in classification of each individual item. Then throw various mixtures into the mix of who allows what to be done, various contractual pricing schemes not seen by the individual consumer, etc. etc. etc. It's a God awful mess in there. THAT is where the administrative costs come from. Not from corporate profits. and seriously, do you think a government operated bureaucracy would have LESS overhead in its' operation? What planet do you live on if you think that?

And when you add back the 20%+deductibles and other out of pocket costs that the insurance in the US makes the patient pay, how does it compare? Otherwise you're saying that paying for all of it is more expensive than paying for some of it, which isn't exactly earth shattering news.

Buying private cover in the UK is surprisingly cheap. A top-up plan for a family of four that covers extras like private hospital rooms and private surgical procedure cost as little as 30 pounds a month. This is because the care offered by the NHS is already to a high standard. Private providers need to compete in order to make people feel that additional insurance has value.

The NHS spends roughly 14% on admin costs within the past decade, less than half of the US. While not an order of magnitude in base 10

Yea, I work as a consultant for one of the big national pharmacy chains, and from what I hear there are some prescriptions where we just eat the cost ourselves because it's cheaper than actually getting the person's insurance to pay for it...

That's the exact opposite economically to produce affordable healthcare for the whole nation. Sure poor people will have little incentive not to come in for every cough but someone will pay for it. That will tax our whole economy, not including dead weight loss inefficiencies.

Cut the 3 billion sent to Israel's military every year. Why subsidize the Israeli social welfare system, when they have a booming economy and the US has bread lines?

I've done just that. More than once. That's why I hope to soon be independently wealthy. I've gone from spending 105% of my take home pay to 40% (admittedly, not all at once, but the first 10% is quite easy).

It's not actually that hard, it's just a matter of priorities, and realizing you're not entitled to something just because you really want it. And it's the only long term plan for financial success. Cutting spending is within your power, and it works. Spending what you think you should be earning i

That's not insightful. The problem is lots of us who have insurance have been getting a raw deal. Including getting dropped when you get sick, having coverage capped, losing a job for being sick and being unable to afford a new plan after you get well (preconditions). The ACA isn't about just those 30 million, or they would've just expanded Medicaid.

I would never call this bill mere tweaks. I can't believe *anyone* would call this bill mere tweaks. Now, as for costs, there are some things that the ACA does. For one, it caps profiteering by the healthcare insurance industry by forcing at least 80% of expenditures to be used on actual healthcare. Second, it makes healthcare checkup plans far cheaper so that people don't ignore small health problems, then run to the ER when their pancreas explodes. I'd google for some of the other cost control measures.

Personally, I wanted a whole-hog UK healthcare system completely run and funded by the government and making doctors and nurses federal employees. What we've got is the best compromise that we could get through Congress. People are criticizing features of the ACA like they slept through the 2 years of rancorous public debate. It's a miracle that we got as much passed as we did.

In the future, when the idiots in this country crying about socialized healthcare understand what it actually means, I foresee a government-run public option being dropped into Obamacare. I also see other future changes like larger penalties for the John Waynes who declare they don't want insurance, but run to the ER when their pancreas explodes.

The health industry is heavily regulated; just about every aspect. The cost of regulation is built in from the Doctor's office to the operating room to the MRI machine. Obamacare doubles down on this. Government is a huge driver of costs and to suggest that it is not responsible for reducing them is just plain stupid.

Yes, because a law that dramatically alters the way your insurance company will do business is just not going to change things for you.

Seriously how naive can you get? I've yet to meet a single person who works in the health care industry who told me that this plan isn't a train wreck in the making, one of them even intends on getting out of the business entirely.

I like how if you complain about government overreach, it's now fashionable for somebody to suggest somalia, as if there's nothing in between this mess and that mess.

Really you have to be a total moron to not be able to understand the difference between anarchists and libertarians. Libertarians want a government, the difference is they want a government that protects you from others rather than you from yourself. Liberals want the later, such as banning trans fats and soft drinks.

And this change for the sake of change is stupid. Personally, when I look at the prices for services that people pay for out of pocket, I notice how cheap yet good they are. Two months ago I paid $40 to get a full dental exam, x-rays, cleaning, and scaling. Meanwhile that same place bills insurance companies $250 for the same service. Why is that? Because when people shop around, they save. Insurance gets rid of the shopping around part because you don't even need to concern yourself with the cost.

Look in other areas traditionally not insured as well - some places offer Lasik for less than it costs to get a new pair of eyeglasses in some cases. I'm not eligible for Lasik (due to keratoconus) but an eye exam usually runs me about $30, whereas insurance companies typically pay about $50.

This is why health care costs are so expensive in the US - and the solution, according to people like you, is more insurance?

The bill did originate in the House, but as a bill concerning tax breaks for members of the military. After it passed the House, Senate Democrats added the healthcare provisions to it, and were able to pass it during the few months when they had a filibuster-proof majority. After they lost their supermajority in the Senate, Congressional Democrats decided the clearest path to law would be to drop the House's original legislation and try to pass the bill the Senate amended. To get enough House Democrats on board to pass it, it was agreed to pass a follow up bill removing some provisions and Obama reinforced the Hyde Amendment preventing federal funds from being used for abortions. The amended bill barely passed the House and was signed into law. The follow up bill originated in and passed the House, and since it was written to only cover budgetary items, it couldn't be filibustered in the Senate and passed there as well, though with an amendment that was re-passed by the House.

Personally, I'm not that bothered by teething problems. Plenty of sites have experienced them. Yes, there are many ways they could have been avoided, but they weren't, and they will undoubtedl be fixed.

More interesting would be to know what penalty clauses are in the contracts? If they were absent, it's a whole lot clearer why these problems have hit. There was simply no financial incentive to design a site that could scale appropriately.

Personally, I'm not that bothered by teething problems. Plenty of sites have experienced them. Yes, there are many ways they could have been avoided, but they weren't, and they will undoubtedl be fixed.

Even assuming that to be true, fixed by when? The law has hard-coded dates in it, and insurers have vast sums at stake predicated on the numbers and types of people signing up, the premiums they'll get, and the subsidies they'll receive. If things slip, lawsuits will fly and it's logical to assume that taxpayers will be on the hook for damages. Not to mention the people who are losing their coverage at work who were expecting to be able to sign up via the exchanges. This disaster has knock-on effects that w

Yes, please, lets mention them. Or wait, we can't because they haven't been stopped. Anyone who had difficulty one day, has been able to get through later that day or the next day at worst. Remind me again what your dictionary has listed for "disaster"?

"Anyone"? It only takes a single counterexample to disprove that, and here I am. I signed up for an account on Oct 1--took me a couple of tries, but I was eventually able to do it. Got my confirmation email, confirmed it, and my account should be active. However, I have never been able to actually log in. When I try, I get a red error message under the username/password boxes saying, "The information you entered isn't valid. Review this information." If I use the "Forgot Password" link in an attempt to reset my password and enter my username, I get an email with a password reset link--so my username is obviously in the DB and associated with the right email address. But when I click that link, I get a page that tells me that "We weren't able to process your request because we couldn't find a Marketplace profile that matched the information that you provided." Wut.

And although it only takes a single counterexample to disprove a universal, I'm certainly not the only person having the exact same problem. Do a web search for those error messages and you'll find many others saying the same thing.

Do we have data showing that penalty clauses either (a) guarantee good rollouts or (b) make the process of getting to a good roll-out [eventually] cheaper? It works like insurance, so you wind up paying for it up-front in the contract anyway...

Also, do we have details on what's going wrong or why? I keep seeing headlines frothing at the mouth, but am given short-shrift on details. Things like:

In a blog post, the Department of Health and Human Services said some users of HealthCare.gov "have had trouble crea

Personally, I'm not that bothered by teething problems. Plenty of sites have experienced them. Yes, there are many ways they could have been avoided, but they weren't, and they will undoubtedl be fixed.

The bigger question is whether the entire ACA will be run the same way.

Even more, more interesting, is what are the penalties applied to individuals who cannot sign up for Obamacare in time because of a broken website. If it's still broken by March 15th (the deadline for individuals to sign up), will the IRS still enforce its penalties, given that the tool the Federal Government provided didn't work?

Hate to rain on your parade, but pregnancy is not an illness or a dysfunction. That being said, insurance is willing to pay for birth control if that's what's in the contract. Some employers CHOOSE not to include that in their insurance contracts, often for religious reasons. . .

If the incompetents stop working, or are consult only, the skill level will rise and no more people will be added.It is likely that a delivery date with follow on support has the headcount winding down anyway, so people are moving on to other projects to destroy already.

I might be over-pessimistic, but I predict that the IT will fail disastrously.

I read somewhere that there are 3 million lines of code holding this together. If that's true, then it will take months for the new guys just to understand it. Then, bug-fixing is going to introduce more bugs. Ultimately, everything will be scrapped in order to start over. (Of course by then a private company would have gone out of business, but we are talking about the limitless resources of the federal government.)

I really didn't feel like trying to work through the HHS org chart and telephone directory to find the name of the project manager and contracting officer in charge of the project. So I wrote, "Obama" as a symbol of the Executive branch, instead. But please, feel free to post someone more specific if you like.

then it is truly screwed, he is out of his depth on this. Those dreamy eyed fools who made the ACA did not realize the implications of it needing an massive IT infrastructure that cannot be crapped out in 3 years and tested for all of ONE FREAKIN DAY when it was completed this month (!!!!). pop up the popcorn kids, this train wreck will be worthy of a Fugative sequel

How is taking over more of the economy an even better idea when the DHHS can't even take over half of medicine? Single-payer is dead in the water and immoral. There is no real way to kill the entirety of Obamacare but Congress should work to mitigate its impending harm.

When the state is your god, you consider it sovereign over all and turn over your will, freedom, respect, devotion and everything you can offer to have it protect you, feed you and care for you. The statist masterminds have yet to achieve this version of heaven they have dreamt up, and they have no interest in mitigating anything. It is the new "moral" imperative to hurt the many to help a few and nationalizing healthcare is key to doing so. See below:

The number of Canadians who receive any health care in the United States for care is vanishingly small. In a country of 30 million people, it is relatively easy to find a few who do so, and who can offer a sound bite for a newscast or an anecdote for a blogger. The fraction of Canadians who receive medical care in U.S. hospitals and clinics appears to be around the 0.5% mark. [healthaffairs.org]--of whom roughly 4 out of 5 do so because they happened to fall ill while visiting the United States, and not because they travelled there to receive medical services.

For certain urgent care services, communities close to the Canada-U.S. border can and do make arrangements to share facilities. (If someone has an urgent need for specialized cardiac or neurological care, you want to go to the nearest major hospital, not just the nearest one on your side of the border. Patients flow in both directions under these agreements; there are regular transfers from northern Washington state to Vancouver hospitals.)

Why does the Elderly death rate in Britain start climbing, late in the summer, and start going down again after the new Fiscal Year starts ??

For that matter, why are so many doctors from Single-payer countries practicing in the States, instead ???

I don't have all the data at my fingertips, but in every year since 2004, there has been a small net migration of doctors out of the United States and in to Canada [aarp.org]. Further, doctors practicing in Canada (and in the UK) report being significantly more satisfied in their jobs that their colleagues in the United States.

Apparently, the performance varies between states since some of the states have their own systems which work rather than the federal default one. I recall hearing that California and New York both had working systems.

A more interesting question is why many of the major beltway tech companies one would expect to find attached to a huge government tech project aren't present. My suspicion is that when they saw the specs (or maybe the lack or vagueness of them) and the due date, they declined to participate.

A more interesting question is why many of the major beltway tech companies one would expect to find attached to a huge government tech project aren't present. My suspicion is that when they saw the specs (or maybe the lack or vagueness of them) and the due date, they declined to participate.

A more interesting question is, how does light manage to act like both a wave and a particle!

Maybe they can swing by all the other failed government IT projects while they're at it. Maybe they can take a shot at Virtual Case File for the FBI. Throwing money at a problem - especially a government IT problem is not going to work.

This does not sound promising. When they say they are bringing in the best of the best to fix this ASAP, best of the best better actually mean something in this case. Otherwise throwing more of what caused this mess in the first place at it will only cause more trouble.

I also have to think: due to the substantial importance, essential timeliness, and over all sensitivity of this gigantic project. Why didn't they simply bring in "the best and brightest from both inside and outside government" to begin with

I'm sure there's tons of people salivating at the chance to jump all over this topic and say things like "classic government inefficiency at work." But the reality is that these kinds of projects happen every day in private sector companies. You only hear about them when they make the news. I've seen many companies throw out millions in sunk costs because they couldn't get an ERP system massaged enough to fit their business processes. Often, the companies realize too late that they're getting bled dry by outsourcing "partners" and getting nothing in return, then make the hard decision to just dump everything and try again.

Some of it may be leadership incompetence (analogous to CIOs getting swindled by consulting salesmen over copious rounds of golf and strippers) but HHS doesn't have hundreds of web developers on staff, and there would be a monster backlash if they actually did go out and hire them as permanent employees. IN the real world, they're forced to outsource to be "good stewards of the taxpayer's dollar" and end up getting crap. I can't believe that no one over the last 30 years has come to the realization that outsourcing always costs more, and results are not guaranteed no matter how much money gets flushed. What probably happened is that the project got awarded to the lowest bidder of the big consultancy firms, who promptly replaced all the super-geniuses they promised with new grads, and just kept collecting money.

A lot of private firms get fed up and just insource the whole thing, but I don't think the government has that option right now. Given the political climate, I'm sure every paper clip purchased is tracked by certain right-wing groups, and hiring hundreds of Federal employees certainly won't go over well. So, we'll just see the same consultancies who screwed up get rewarded to "fix" the problem. Just like in the private sector...

As a former government software developer, I can honestly say that it's just not a worthwhile place to work, hiring caps or not.

Well, let me correct that. If you're willing to have that be the last place you work in your career, and you're willing to find job satisfaction outside of work, and you can handle both the intense frustration of being prevented from doing your job properly, with being badmouthed by politicians for not doing your job properly, then it can actually be an okay place to work.

It was smart to build in the 3 month cushion, but that site is driving me nuts. First I dealt with 2 weeks of not even being able to log in (getting dropped to blank screens). Then I had registrations blow up over and over forcing me to repeat the process. Then, when I finally got my account set up, I had deal with Experian's validation blowing up, then being told to wait 24 hours for the fix, then calling back and finding out there was nothing Experian really could do and just call healthcare.gov help,

I think this might be the first goverment case of a large organization trying to execute a publicly facing software project and failing. For decades the goverment didn't do public facing benefit projects. If this all happened in the 90s you would have to sign up using paper forms and although it may have been slow and inconvenient by today's standards that's what the goverment had experience in doing, it probably would have worked just fine.

I think software/web centric failures like this are going to keep happening. Few organizations, especially those whose primary business isn't software, are good at implementing huge software projects. Most management doesn't know how to run software projects, budget departments dont know how to account for software projects. If the Social Security administration has a huge backlog of applications they just add more people to the workforce until they work through it. Now everything is different, it doesn't matter how many people and how much money you throw at it, it's going to talk a while to fix. Very few people in goverment, and very few members of the electorate understand how a software project is run, hence a "surge" to fix the problem. People understand that concept, they imagine tons of nerdy looking guys flowing into some building and typing furiously at a keyboard until the problems go away. Good imagery, not really accurate.

I'm actually really amused by all this, it's my job playing out on a national stage. Terrible software estimates, contractors failing to live up to contracts, unrealistic timelines, poorly understood requirements, angry management demanding all hands on deck, and unhappy users. Maybe now software management will become an academic subject and mandatory study for MBAs and such.

What I was trying to say is that the government is now experiencing the same challenges a lot of companies and other large organizations deal with. The government is just doing it on a national stage, while also forcing millions of people to use the site.

The fundamental difference between a government project and a private project is the "required by law" part - you can't be forced to use a private website, but the gov's website has tax penalties associated with it.

Another conspiracy theory I heard was that Democrats wanted Obamacare to fail so that in ten years they'd propose fixing it with single-payer. Since Obamacare can't fund itself and the website is a tort law travesty which sounds more likely?

I think the more likely situation, if there was a conspiracy at all, would be that they would wait for the private insurers to have a crack at this for a few years, then people would see that no one's rates will decrease and that the private companies are just pocketing the difference.

I'm all for single-payer, complete with death panels. NHS in the UK has huge costs too, but at least they know when to give up on treating someone. (See the Quality-Adjusted Life Year -- we need a metric like that in our healt

Allegedly the DHHS originally assumed most states would run their own website for such because a lot of the service comparing info is state-centric anyhow.

However, many red states refused to go along out of their usual anti-federal-government stance. This put more burden on the DHHS to handle the red-state traffic and their state-specific logic, and Congress refused to fund the extra resources needed.

If this is the case, then the GOP is creating a self-fulfilling prophecy.

Add to that the pool of Fox reporters constantly clicking "Refresh" on the main page hoping for an error screen to appear so they can screenshot it and make it into a half hour news segment, and yes the load was more than the system was designed for. Given that users have from Oct 1 to Dec 31 to successfully sign up before any consequences of any sort (in this case they are tiny) kick in, the service doesn't need the availability of a stock brokerage or bank in order to be successful. Yet, it's being echo

It's a little true, but with a lot of spin. They were warned (by the GSA iirc) months in advance that their estimates for site traffic were way, way, way too low. It wasn't any last minute surprise that 36 states are using the Federal website instead of running their own.

I nominate for worst analogy of the day.Zero of the fifty states are sovereign, nor has any state ever been (any state that was once a sovereign nation gave up that sovereignty upon acquiring statehood). There is a separation in powers between states and feds, but it is absolutely nothing like the UN and member nations. The UN cannot make and enforce laws in member nations, the Fed can make and enforce laws in states. You could argue that healthcare is the responsibility of states, not the Fed, but that's a

I guess you never thought about what "United States" means. We have a federal government, not a national one. (don't argue the semantics, I'm using the terms a bit imprecisely to draw a distinction) We are a country of United States, not a country divided into states.

"The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States", "The powers not delegated to the United States by the Consti

The Articles of Confederation have not been in use since 1789... so I think we can safely discard them in any discussion about modern states. One of my professors pointed out an interested change in linguistics after the Civil War. Prior to the war, "United States" was almost always a plural ("The United States are...") but after the war, it became a singular noun ("The United States is..."). The Civil War was basically the end of the question of state sovereignty in the US. It's also one of the reasons the Confederate States were a confederation (and not a federation)... confederate states are independently sovereign and can freely secede from the confederation, but in a federal government, they have shared sovereignty with the federal government at best.

The Constitution limits the sovereignty of the states, but does not take it away completely. A state may not enter into a treaty with a foreign power, but they have complete autonomy with how they issue a building permit, or prosecute a murder case. So they may not be sovereign states from the perspective of the UN, but they have a great deal of sovereign power independent of the US Federal Government. If you look at it from a States' rights perspective, the Civil War was fought over how much autonomy th

Your right, and that was in the Bill. There are states like Kentucky and Washington that have their own sites running. The Feds were only going to run the exchanges for the states that didn't want to do it themselves

Nice trolling.1. The site was put together by Bi-partisan beltway bandits. No cronies needed to be brought in.2. Healthcare will still be run by private insures, so the hand sitting beureacrats will be those of the private sector, that have been hand sitting for every one else who already has insurance.3. Your a moron.